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Re: 20%?

Posted by inertia on August 1, 2002, at 18:50:33

In reply to Re: 20%?, posted by Phil on August 1, 2002, at 6:15:48

> pharmrep, Are you saying Celexa is around 20% sexual dysfunction, mostly delayed ejaculation?
> Or are you saying only 20% will talk about it?
> I would think in the real world that it's 50-70%.
> And from personal experience, the sexual problems are more varied. I'm taking 40mg, down from 60mg and don't even think about getting as far as ejaculation. I take Wellbutrin and Adderall and Viagra occasionally and I've still written off sex. It's so frustrating, it's not worth the effort.
> I cannot believe the numbers that companies get away with putting on package inserts.
> Do you, as a rep, encourage doctors to bring the subject up with patients or does every rep say, well, patients just don't want to talk about it.
> If you know that's true, why don't $200.00 an hour psychiatrists bring the subject up? I think that nobody, including drug companies and doctors, want to bring it up. It's difficult to say anything in a 15 minute med check.
> Is Forest aggressively trying to overCOME this problem? The first company that makes an effective AD without this SE will never have cash flow problems again. I'm sure pharm co. are aware that they could make a fortune.
> What's the figure going to be on Lexapro..2%?
> Have you ever been on meds? Does your company realize that the choice we are given is semi-normalcy at the expense of sex? Semi-normalcy at the expense of 100% apathy?
> Not trying to blame you for the world's depression problems but after 20 of my best years spent on meds, it's all getting a bit tiresome.
> Phil

Phil, I think your guess-timate of sexual s/e in 50%-70% of SSRI users is right on target.

I hope this isn't overkill, but I looked for all the GOOD studies on sexual dysfunction from different antidepressants and the 50%-70% is just about what they found.

I included one abstract on the TYPE OF QUESTIONAIRE the Salamanca group used to get their data so you could see that they have a pretty valid measuring instrument.

Study design is EVERYTHING. Generally I think you should be skeptical of any study sponsored by a pharmaceutical company (unless, maybe, the researchers are known to be of top-notch caliber) and you want to see a result replicated by other researchers.

The German study below is interesting because it shows that when MDs used their (presumably sensitive) questionaire to ask about sexual s/e they came up with a vastly greater incidence than if they left it to the patients to mention it (61.5% vs 21.6% for SSRIs).

1) Authors .Ferguson JM. Shrivastava RK. Stahl SM. Hartford JT. Borian F. Ieni J. McQuade RD. Jody D.
Institution Pharmacology Research Corporation, Salt Lake City, Utah, USA.
Title Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline.
Source Journal of Clinical Psychiatry. 62(1):24-9, 2001 Jan.

Abstract BACKGROUND: Several different classes of antidepressants have been associated with sexual adverse effects. This double-blind, randomized trial compared the effects of nefazodone and sertraline on reemergence of sexual dysfunction in depressed patients who had experienced sexual dysfunction as a result of sertraline treatment. Depressive symptoms were also monitored. METHOD: One hundred five patients with DSM-III-R major depressive episode who were experiencing sexual dysfunction attributable to sertraline (100 mg/day) were screened for entry. Eligible patients entered a 1-week washout period that was followed by a 7- to 10-day single-blind placebo phase. Patients without symptoms of sexual dysfunction at the end of the single-blind placebo phase were randomly assigned to receive double-blind treatment with either nefazodone (400 mg/day) or sertraline (100 mg/day) for 8 weeks. RESULTS: Nearly 3 times more sertraline-treated patients (76%; 25/33) experienced reemergence of sexual dysfunction (ejaculatory and/or orgasmic difficulty) than did nefazodone-treated patients (26%; 10/39) (p < .001). In addition, patients treated with nefazodone were more satisfied with their sexual functioning than were patients treated with sertraline. Both treatment groups demonstrated a similar and sustained improvement in depressive symptoms. Both drugs were well tolerated, and the overall incidence of adverse reactions was similar for both treatment groups; however, 9 sertraline-treated patients (26%) discontinued because of adverse events compared with 5 nefazodone-treated patients (12%). Of the patients discontinuing therapy for adverse events, 5 of the sertraline-treated patients did so because of sexual dysfunction reported as an adverse event, whereas only 1 of the nefazodone-treated patients discontinued therapy secondary to sexual dysfunction. CONCLUSION: In this sample of patients with major depression who had recovered from sexual dysfunction induced by treatment with sertraline, nefazodone treatment resulted in significantly less reemergence of sexual dysfunction than did renewed treatment with sertraline and provided continued antidepressant activity.

2) Authors .Montejo AL. Llorca G. Izquierdo JA. Rico-Villademoros F.
Institution University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain.
Title Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
Source Journal of Clinical Psychiatry. 62 Suppl 3:10-21, 2001.

Abstract BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.

3) Authors Montejo AL. Garcia M. Espada M. Rico-Villademoros F. Llorca G. Izquierdo JA.
Institution Hospital Universitario de Salamanca, Facultad de Medicina, Universidad de Salamanca.
Title [Psychometric characteristics of the psychotropic-related sexual dysfunction questionnaire. Spanish work group for the study of psychotropic-related sexual dysfunctions]. [Spanish]
Source Actas Espanolas de Psiquiatria. 28(3):141-50, 2000 May-Jun.

Abstract BACKGROUND: The presence of sexual function impairment in patients with psychiatric disorders is very common and could be an effect of the medication (mainly antidepressant and neuroleptics). The patient frequently has difficulties to communicate this adverse effect and the assessment of these changes by the physician should be encouraged. The real SD incidence is underestimated and the use of a specific questionnaire is needed. METHODS: The authors analyse psychometric characteristics of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) that includes questions about libido, orgasm, ejaculation, erectile function and general sexual satisfaction. The questionnaire was applied to 62 patients who were taking nefazodone "de novo" (n = 18) or were switched to nefazodone (n = 44) due to bad tolerated sexual dysfunction secondary to other antidepressant. RESULTS: The PRSexDQ has shown an excellent feasibility with nil percentage of patients with missing responses on all items except on items 1 and 2 (1.7% and 15.5% of patients with missing response). Cronbach's alpha value was 0.93, which indicates adequate reliability. The PRSexDQ also showed adequate construct validity. As it may be expected, the PRSexDQ showed a high correlation with a Clinical Global Impression scores on Sexual Dysfunction (r = 0.79) and moderate correlation with Hamilton Depression scores (r = 0.63). PRSexDQ also showed good discrimination between naive and pretreated depressed or dysthymic patients, with statistically significant differences between those groups of patients. Finally, the instrument showed adequate sensitivity for detecting clinical changes on sexual dysfunction with greater changes in the patients treated previously with antidepressants and who were switched to nefazodone than in naive patients (SES = -3.77 in patients switching to nefazodone; SES = -0.64 in naive patients).

4) Authors Arias F. Padin JJ. Rivas MT. Sanchez A.
Institution Unidad de Psiqiatria, Fundacion Hospital de Alcorcon, Madrid.
Title [Sexual dysfunctions induced by serotonin reuptake inhibitors]. [Spanish]
Source Atencion Primaria. 26(6):389-94, 2000 Oct 15.

Abstract OBJECTIVE: To assess the incidence of serotonin reuptake inhibitor (SRI) antidepressant-induced sexual dysfunction (SD) and to compare the sexual side effects of SRI. DESIGN: Naturalistic, prospective, observational study. SETTING: Two urban health centers. PATIENTS: 235 outpatients (164 women, 71 males) who began treatment with some of the following SRI: fluoxetine, sertraline, paroxetine, citalopram and venlafaxine, who had engaged in regular sexual practices with stable partner, who were suffering from different mental disorders who were being treated with SRI. The assignment to each group was according to clinical criteria. INTERVENTIONS: Patients completed questionnaires that allowed reporting of both SD induced by the illness and the treatment, evaluating changes in libido, arousal, and orgasm. The patients were observed over 6 months of treatment. RESULTS: 147 patients (62.6%) reported one or more SD related to SRI treatment. There were differences in the incidence between the different SRI: 39% with fluoxetine, 75.5% with paroxetine, 78.8% with sertraline, 28.9% with citalopram and 80% with venlafaxine. In 78.2% of patients the SD showed no improvement by the end of this period. In a predictive logistical regression model of the presence of SD induced by the SRI, the female category and the presence of previous sexual problems were favourable predictors and the treatment with paroxetine, sertraline or venlafaxine were increased the risk of SD. CONCLUSIONS: SD is one of the most frequent and persistent SRI adverse effect. We recommended to inquiry about SD in patients who were treated with SRI. Significant differences were found in the occurrence of SD between the different SRI. Such data would be particularly valuable to physicians when choosing a specific antidepressant from this therapeutic group.

5) Authors Philipp M. Tiller JW. Baier D. Kohnen R.
Institution Bezirkskrankenhaus Landshut, Klinik fur Psychiatrie/Psychotherapie, D-84034, Landshut, Germany.
Title Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. The Australian and German Study Groups.
Source European Neuropsychopharmacology. 10(5):305-14, 2000 Sep.

Abstract OBJECTIVE: To compare the emergent sexual effects of moclobemide and selective serotonin reuptake inhibitors (SSRIs) during acute and maintenance therapy in routine practice. METHOD: 268 patients were evaluated for sexual function at baseline, 6 weeks, 3 and 6 months of treatment using physician ratings and self-rating questionnaires. Patients received moclobemide, an reversible monoamine oxidase A inhibitor (RIMA), or a SSRI (fluoxetine, fluvoxamine, paroxetine, sertraline). RESULTS: Baseline values were similar in all groups. Incidences of impairments of sexual functioning with treatment, whether clinically relevant or not, were 24.3% with moclobemide and 61.5% with SSRIs (physician ratings), with no significant tolerance to these effects. There was a suggestion of differences between the SSRIs in their specific dysfunctions they cause. SSRIs (21.6% of patients) had about ten times the moclobemide rate (1.9%) of sexual dysfunction reported as adverse events. Antidepressant efficacy was comparable between treatments. CONCLUSION: In patients for whom sexual function is important or sexual dysfunction is present, moclobemide should be considered a first line antidepressant.




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